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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: ( <br /> r)II III PHS-EH LOG # `- <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: So;i s� iP .-P S�� �/ ;: �`_+•� <br /> --,-- - �- t.. Phone: <br /> Company: -Se 6 , ' h G/ -41f <br /> Address:—.. �7oo ,3e ks ��� .. r`��� :-�t,�.C,, sic <br /> Designated Employee Name: �2u— z- ��. <br /> Phone- <br /> om_. YReporting Agency Name: v� <br /> Address: us s A,1, 5 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 'mac 11�-1410 <br /> (Best Physical Description) County) Circle One <br /> Date of Discharge: <br /> Date Notified: _ '/i��y Z Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: les ;i Telephone: &9 Y�G al <br /> Physical Address: 1-2o-7 C4 - <br /> Mailing Address: _ C>, /�Sv x (P vim '," -5tvG l f»'n .G9 9�• J O c ,f. -. <br /> E. DESCRIPTION , <br /> Type of Discharge: <br /> Volume: /c v�•-► ii' <br /> Chemicals: <br /> Circumstances: <br /> w <br /> F. ACTION TAKEN v CL, K/C"r /-�1-'11 <br /> I1 <br /> y <br /> ii <br /> SITE <br /> /DISPOSITION <br /> �WY-�dt/il,�� C��Sr's Sirr-Oic 7� �l r'���r?,_,ii�CPfsl!/_1y /�"� CIC°f�.l Ari/�i1— Y�V irr�•f/� � cAYh�Et7� <br /> ii <br /> EH 22 013 (Rev.4/91) <br />